Provider Demographics
NPI:1225664642
Name:DESAI, PRIYA DIPAK
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:DIPAK
Last Name:DESAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3727 SW DURHAM DR APT 203
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3781
Mailing Address - Country:US
Mailing Address - Phone:864-431-3427
Mailing Address - Fax:
Practice Address - Street 1:2512 HILLSBOROUGH ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7249
Practice Address - Country:US
Practice Address - Phone:919-516-5718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist